Tag Archives: Pediatrics

Pediatrician Perri Klass has an excellent article on antibiotics and children in Tuesday’s New York Times Science Times. She perfectly conveys the dilemma facing pediatricians and others who care for children today. We all have stories of kids whose lives were saved by the timely administration of antibiotics, but we’re also acutely aware–more so with each passing research article–of the consequences of overusing that “magic bullet.”

The physicians who taught me back in the ’70s and early ’80s had good reason to love antibiotics. Many of them had started their careers in the pre-antibiotic era, when infections like pneumonia, meningitis, diphtheria, and others killed a lot of children. Then antibiotics came on the scene and those diseases nearly vanished–until antibiotic resistance kicked in with a vengeance, that is. We’ve been engaged in an escalating arms race with bacteria ever since.

The pro-antibiotic mindset of those times was epitomized by an elderly attending physician in my residency program who, as we were discharging a boy who’d had bad case of pneumonia, quietly said, “When I was an intern that child would already have been dead for a week.”

To his younger self, the boy’s recovery would have been a miracle. Now he believed it was simply a matter of time–and the right antibiotics–and bacterial infectious diseases would disappear entirely. Side effects? Maybe some diarrhea or the occasional allergy, but that was a small price to pay. Right?

It didn’t work out that way, of course. We’re now learning that antibiotics can have far-reaching effects on children’s health. As Klass points out, there is concern that antibiotic use, particularly in early infancy, may be linked to a variety of chronic health conditions–even obesity, as I wrote about a few months back.

Still, there is a role for antibiotics. Kids still get pneumonia, and meningitis, and any number of infections that may come roaring back if the fear of antibiotics becomes its own epidemic. But not every ear infection needs to be nuked with pharmaceuticals.

So, when to treat and when to let nature take its course? That’s a delicate balance that those of us who learned from doctors who saw antibiotics as a “magic bullet”–which they were, at least at the start–are still working to achieve.

When a group of 49 New York teens with MetS was compared with 64 normal-weight kids, the MetS teens had lower scores on tests of mental ability, arithmetic, and reading. In addition, MRIs showed that the typical MetS teen had a smaller hippocampus than his or her normal classmates–that’s the part of the brain that deals with memory formation and storage. Such changes in adults had been thought to be the result of long-term metabolic disease; the discovery of similar changes in teens was unexpected, and scary.

Are these changes permanent? Does the brain recover if a teen loses significant weight and reverses his or her metabolic syndrome? No one knows for certain as yet, but this study adds a bit more urgency to the fight against childhood obesity. As Dr. Antonio Convit writes in the study’s conclusion:

“Although obesity [alone] may not be enough to stir clinicians or even parents into action, these results in adolescents strongly argue for an early and comprehensive intervention. We propose that brain function be introduced among the parameters that need to be evaluated when considering early treatment of childhood obesity.”

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* Metabolic syndrome is defined by the American Heart Association as the combination of high blood sugar, elevated blood triglycerides, reduced “good” cholesterol, abdominal obesity, and high blood pressure.